Journal Article

Enteropathic arthritis is associated with an increased risk of major adverse cardiovascular events and venous thromboembolism

Williams, Jacob C, Kieu, Phuong Le, Zhao, Sizheng Steven, Alam, Uazman, Zuckerman, Benjamin P

2025

Overview

Abstract Objectives To assess the risk of major adverse cardiovascular events (MACE) and venous thromboembolism (VTE) in patients with enteropathic arthritis (EA) compared with matched controls. Methods We performed a 1:1 propensity score matched retrospective cohort study using electronic health records. EA was defined using International Classification of Diseases, 10th Revision code M07 and codes for Crohn’s disease or ulcerative colitis, excluding other inflammatory arthritis. Controls had no coded diagnosis of Crohn’s disease, ulcerative colitis or inflammatory arthritis. Primary outcomes were MACE and VTE; secondary outcomes included myocardial infarction (MI), stroke, CVD (composite of ischaemic heart disease and cerebrovascular disease), pulmonary embolism (PE) and deep vein thrombosis (DVT). Cohorts were matched for demographics, comorbidities and medications, with analysis using Cox proportional hazards models. Results We included 5239 matched pairs (mean age 43 years, 63% female), with follow-up of 19 256 person-years (PY) for EA and 42 064 PY for controls. MACE [261 events; incidence rate (IR) 13.6/1000 PY (95% CI 11.9, 15.2)] occurred more frequently in EA compared with controls [407 events; IR 9.7/1000 PY (95% CI 8.7, 10.6)]. Similarly, VTE occurred more frequently in the EA group, with 264 [IR 13.7/1000 PY (95% CI 12.1, 15.4)] compared with 250 events [IR 5.9/1000 PY (95% CI 5.2, 6.7)]. The hazards of MACE [HR 1.40 (95% CI 1.19, 1.66)] and VTE [HR 1.89 (95% CI 1.57, 2.27)] were significantly increased. Results were concordant across CVD, MI and PE, but lacked precision for stroke and DVT. Conclusion EA is associated with an increased risk of MACE, VTE, MI, CVD and PE. Risk-reduction strategies and lifestyle measures should be clinical and research priorities. Lay Summary What does this mean for patients? Enteropathic arthritis (EA) is a condition that may occur in people with inflammatory bowel disease (IBD). This condition affects the joints, causing swelling, pain, stiffness and back problems. IBD and similar joint problems increase the risk of heart attacks, strokes and blood clots. We do not know whether people with EA also have an increased risk of these problems. In our research study, we looked at the healthcare records of >5000 people with EA and >5000 similar people without EA. We compared the groups to see how many people with EA had a heart attack, stroke or blood clot, compared with people without EA. We found that people with EA had an increased risk of having a heart attack or a blood clot in their lungs. People with EA should be given advice to reduce the risk of these, including stopping smoking, as well as diet and exercise advice.

• Publisher: Oxford University Press
• Subject: Arthritis / Blood clots / Crohn's disease / Heart attacks / Inflammatory bowel disease / Stroke / Thromboembolism